COMMUNICABLE DISEASE REPORTING AND INVESTIGATIONS

7.1 Summary

Mandatory communicable disease reporting affords public health officials with the opportunity to investigate communicable diseases and take action to protect the health of the community. Identification and reporting of communicable disease is a collaborative effort among physicians and other health care providers, veterinarians, hospitals and other health facilities, laboratories, and the local public health system. Timely reporting of the specific illness or condition, as well as any unusual manifestations of disease, will allow public health officials to determine if further action is necessary to protect public health, such as isolation or quarantine of an individual or group of individuals. Thus, communicable disease reporting and investigation is an integral part of public health emergency law.

Before action is taken, it is critical that officials have a thorough understanding of the disease in question, including issues such as mode of transmission (i.e., airborne or through contact with bodily fluids) and how long the disease incubates in an affected individual before they become contagious (the incubation period). Thus, District of Columbia (District) epidemiologists should be consulted before action is taken.

Chemical and radiological agents and other toxic conditions are included within the definition of a communicable disease. Accordingly, communicable disease reporting in the District of Columbia (the District) is not limited to traditional infectious diseases, and diseases that have or could result from exposure of individuals to chemical or radiological agents or other toxic conditions must also be reported to the Director of the Department of Health (DC Health Director).

As many diseases are transmitted via animals and vectors (i.e., mosquitoes), see section 13.0, for additional information.

A health care associated infection (HAI) is defined as infection that develops in a patient or resident in a healthcare facility that was not present or incubating at the time of admission. An HAI outbreak is the occurrence of more cases of infections than expected in a given healthcare facility area among a specific group of people over a particular period of time, or when the number of infections in a healthcare facility is higher than the baseline rate for that facility. 22B DCMR § 299.1.

A foodborne disease outbreak is defined as an incident in which two or more persons experience a similar illness resulting from ingestion of a common food. 22B DCMR § 299.1.

These diseases must be reported to the DC Health Director in writing within 24 hours after provisional diagnosis or the appearance of suspicious symptoms:

These diseases must be reported to the DC Health Director in writing within 24 hours after provisional diagnosis or the appearance of suspicious symptoms, but only if there are 3 or more cases that occur within a 7-day period in a school or childcare facility:

7.3.3 Persons and Entities Having a Duty to Report and Special Reporting Obligations

Physicians and Other Health Care Providers – Physicians and other health care providers are required to report communicable disease cases as described above. In addition, physicians and other health care providers must report information regarding carriers or contacts to the DC Health Director. 22B DCMR § 202.3.

Physicians and other health care providers must advise the infected adult or the infected minor’s parent or guardian of the applicable requirements for isolation, quarantine, and restriction of movement. 22B DCMR § 202.4.

Physicians who are treating or caring for a person with a communicable disease must immediately report the name, address, and other relevant information to the DC Health Director in the following circumstances:

When the person is delinquent in treatment;

When the person violates isolation or quarantine; and

When there is any change in location of the case (must be reported to the DC Health Director by phone or in writing within 24 hours of the change).

In addition to the duty to report the diseases described above, physicians and other licensed health care providers must report an HIV/AIDS diagnosis, as well as a pregnancy in an HIV-infected woman, to the DC Health Director within 48 hours of diagnosis and furnish information the DC Health Director deems necessary to complete a confidential case report. 22B DCMR § 206.2. These reports must include the following information:

Protected health information (PHI) which is protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), may be disclosed for public health activities, including disease reporting and surveillance. See section 10.4.4 B.

Veterinarians – Veterinarians are required to report communicable disease cases as described above. In addition, veterinarians must report information regarding carriers or contacts to the DC Health Director. Such reports must include a statement of the instructions provided regarding isolation, quarantine, and restriction of movement. 22B DCMR § 202.1-202.3.

Veterinarians must advise the person in charge of the infected animal of the applicable requirements for isolation, quarantine, and restriction of movement. 22B DCMR § 202.4.

Veterinarians or other persons who have reason to suspect any of the following must make an immediate report to the DC Health Director by telephone, followed by an immediate written report to the DC Health Director:

A dog or other animal is suffering from rabies;

A dog or other animal has been bitten by or exposed to a dog or other animal suffering with rabies; or

A person with potential rabies exposure as a result of having been bitten or exposed to a dog or other animal.

If a report is made to a member of the Metropolitan Police Department (MPD), DC Health Animal Services Animal Care and Control Fields Services Division, or a privately owned veterinary hospital or clinic of any of the foregoing events, such event must be immediately communicated to the DC Health Director, followed immediately by a written report to the DC Health Director.

Schools – Schools are required to inform the DC Health Director within two hours when any student has contracted the following diseases:

Laboratories – A laboratory that tests a communicable disease specimen must report its findings directly to the person who submitted the specimen. In addition, laboratory operators must report positive tests for syphilis to the DC Health Director in writing within 24 hours, including the name and address of the person requesting the test. 22B DCMR § 211.3. Laboratory operators must also report HIV positive tests, as well as tests that are indicative of an HIV diagnosis such as CD4 and viral load tests, to the DC Health Director or his/her designee in writing within 48 hours and include the following information:

The name of the subject of the test;

The name and address of the physician or provider requesting the test; and

Blood Banks – Physicians in charge of blood banks must report positive tests for syphilis to the DC Health Director in writing within 24 hours. Physicians in charge of blood banks must also report HIV positive tests to the DC Health Director in writing within 48 hours. 22B DCMR § 211.8.

Child Care Facilities – Child care facilities must immediately report to the DC Health Director the presence of an individual who has or is reasonably suspected of having a reportable communicable disease. 29 DCMR § 322.1.

Order an individual having or suspected of having a communicable disease, or of being a contact or carrier of a communicable disease, to submit to an examination. 22B DCMR § 210.4; and/or

Order an individual having or suspected of having a communicable disease, or of being a contact or carrier of a communicable disease, to submit specimens of body secretions, excretions, fluids, and discharges for laboratory examination. 22B DCMR § 210.5.

In addition to controlling and investigating communicable disease, District officials also have the authority to control and investigate public nuisances. A public nuisance is defined as “an unreasonable interference with a right common to the general public.” Restatement (Second) of Torts, § 821B(1) (1979); B & W Management, Inc. v. Tasea Inv. Co., 451 A.2d 879 (D.C. 1982). In the public health context, public nuisances arise from actions that affect the health or safety of the community; the police powers of state government allow it to take action against the public nuisance. For example, failing to follow specific guidelines with regard to swimming pools and spas constitutes a public nuisance. 25-C64 DCMR § 6463.1(o). See section 13.0 for specific nuisance powers with regard to vectors (e.g., mosquitoes, ticks) and rodents.

7.5 Reporting Deaths from Communicable Diseases

Physicians are required to immediately notify the DC Health Director by telephone when they issue a certificate of death due to: